How can I get my Parents to Consent to Move to Assisted Living?

I have learned in my own practice in this area that two other ingredients are essential:
1. Better to explore the senior's needs, hopes, wishes, strengths, and limits with a neutral and, along the way, include the children. Reaching an agreement is superior to "convincing," which more often than not fails to achieve the goal of renewed life and calmness.
2. "Right-sizing" better describes the realities and goals than "down-sizing." Indeed, much of our lives, including careers, partnerships, and residencies, is about finding the right fit given our needs, hopes, wishes, strengths, and limits.
Rabbi Scott B. Saulson, PhD

Our family convinced our 90 year old mother to move close to three of her children, because she had fallen several times, had a fender bender or two, her eyesight was getting worse, her hearing was getting a lot worse, and the relatives living close to her had called us and said someone needed to live with her. We tried to find someone to do this and she objected. Our mother wanted to stay independent, living by herself as she had done since our father's death, 38 years ago. My sister found her a beautiful place that served two meals a day, had covered walkways, beautiful oak trees, pool, golf course, many activities, transportation and evening and morning check in with the facility. She had about 1200 square feet of living space. She hated it from day one. She refused to participate in any meals or activities, she lost weight and was constantly complaining about the facility. We finally called in everyone for an emergency family meeting to see if we could not make her understand she had to accept her new arrangements. She absolutely refused. She has always been difficult and demanding. She had several tanturms to the point we had her evaluated for mental illness. Finally, we moved her two times more, and purchased her a life line as she did not want anyone to monitor her. After several more falls and finally a broken hip has put us in a new situation. Out of five children, four have serious health issues and we are all over sixty. She is in a wonderful facility for rehab and nursing. Even though, she has always been very active, this hip break has scared her. She is rapidly recovering, now 93 years old. She has started talking about going home and has stated if she has to stay in a place like this ( a wonderful place) she would give up. What she does not know, as we are not sure of recent results of a recent cat scan, she may have pancreatic, liver, kidney cancer. We are at a loss of what to do if this turns out to be true, hopefully not. Even if it is not cancer, she is still legally blind and deaf in one ear and hearing loss in the other and should have 24/7 care. She does not want to live with any of us as some of us have tried this in the past, and she did not like it, at all. We found in home care will be very expensive, and they would only last a few days. She does not have the income or assets for this to happen even if all her children helped with the expense. I guess what I am asking is what would be the best way to tell her that a facility is the only answer? My sister and I are faithful with daily visits, doing little things for her and so on? We most certainly will not abandon her. Our brothers live miles away and are in hiding. I am at a total loss if she goes south on us. Even if she is difficult, she is my mother, and I will care for her as long as I am able. I guess I am just venting, help!!!!

ANYONE KNOW WHERE i CAN GET LIFE INSURANCE 3 YRS. AFTER STROKE?

Respect for your mother and her needs cannot come at the price of disrepsect for your own needs and limits. Your mother's always being difficult does not give her license to be difficult now, certainly not at your own financial and mental peril. If she is competent, which may not be the case, then she will have to arrange to get what she wants without you. Otherwise, she will have to respect what you can and cannot do. That you cannot do everything you wish maybe a cause for regret and sadness, but not a cause for guilt. Within these parameters you can still care for her while caring for yourself.
Rabbi Scott B. Saulson, PhD

I believe it is also important to review the assisted living facilities spend down policy. Where does mom go when she runs out of money? Many faith based communities have special funding to permit assisted living residents to stay after they have spent down their assets. Ask this question before you move in!

Joseph

ssaulson: I am happy that you addressed the issue of employing "inclusive" language. I think that we all have a natural resistence to someone trying to "convince" us of anything that we really did not want to do. I agree that starting these conversations sooner than later helps. I never want to make decisions for my Mom that are made solely for my convenience. I want the best surroundings for her...where she feels both comfortable and safe...she did the same for me as a child! It just seems that there is such a big gulf between aging-in-home and assisted living facilities. I wish she could stay in her home with some live-in help. Unfortunately, Medicare has a dim view of subsidizing this living arrangement. We need to be more vocal in advocating for our seniors and our government needs to "pay it forward" and not "warehouse" them.

I love the term "right-sizing" it implies growth rather than loss. It has made me start thinking of how I want my future to look.
Lilli

I am an in-law, but I am certain that my in-laws are ready for assisted living. My sister-in-law does not recognize the benifits and pluses of a facility, and that it would be in the best interest of her parents as well.She is in denial that her parents are aging and ready, which i understand,but do not think is in their best interest at all. My husband is aware, but is emotional torn between reality and his own feelings of dealing with his aging parents. What do I do to get everyone on the same page and realize it is time for them to move, so they can enjoy the final years of their lives and not just exist.My mother in-law needs a multi-level of care facility at this time as she has cll, leukemia and gets ill from time to time. My father-in law is definitly showing beginning signs of dementia, he gets his days and nights confused and tends to get aggitated with the sctivities of daily living. He does not properly care for himself.They are not on the same level of care, but they should remain together...how does this work?

Great Post Jacqueline,

This is a fantastic post. I really liked No. 6. That is so smart.

Best,
Bill

I have a similar situation to CAC, who posted on 9/18/09...
My elderly mother of 88 years is very independent, stubborn, and has lived alone for 3 years since my father passed away. She
has been diagnosed as having "mild cognitive impairment" --- the gentle way of calling it Dymentia. She is in a stage where she believes that people are coming into her house and hiding her belongings, including her medication, car and house keys, and her wallet. Her forgetfulness has caused her to misplace items around the house, yet she blames mysterious people who creep in after midnight. She wobbles when she walks, and has fallen at least half a dozen times. She has placed a metal tray in the microwave oven. But she insists that she is the only one living at the house, thus SHE must take care of it. And so, she won't move away. All this risky and rather dangerous behavior has prompted my sister and I to research the assisted living places with memory care wings. What really troubles us is HOW we can convince mom to leave her house. Because she really doesn't understand her dangerous behavior, she absolutely won't be convinced that she must move to safer surroundings. We are open for suggestions on how to accomplish this, even if we have to fabricate a "story" that convinces mom to leave her house.

1,000 apologies as this is windy, but assured to be quite helpful! You might want to copy/paste it into a larger document window for easier reading~and passing it on!

My Gram is a widowed 85 yr old, type II, CHF with pacemaker, compromised GI tract, and dependent on a couple dozen medications. She is deemed "lucid," if you consider the mentality of a spoiled toddler as lucid. Being a pragmatic Type A with a savior complex, and a long time Technical Writer, I sprung into action recently~having absolutely no idea of what I was getting into~when my Gram collapsed in her bathroom (after two dozen "lucky" falls during the last two years), fracturing her ankle. I've a giant binder labeled "The Eleanor Project" containing her organized documentation (ss card, health ins, life ins, medical history, med list, legal docs and copies, contact info for all her doctors and case workers, bath lady, etal.).

Realistic Tip 1: Get the legal docs together that give you access to all patient information as well as to identify you as the "point man" for implementing decisions. Durable Power of Attorney for Healthcare, the HIPAA sheet that goes with it, a Healthcare Directive (replaces the archaic "living will"), Durable General Power of Attorney, and a Last Will and Testament. These are all online and free, you need only search for them so look closely as some may vary by state. Gotta get 'em notarized and witnessed, but you can do that at the doctor's office, hospital, or rehab center, etc. Remember to reiterate to your patient that you have no immediate power over them just because they've signed these legal docs. I clarified to my Gram that her signing the forms are to ensure that if she falls again, conks her head and can't speak, she won't end up in an asylum where mad scientists might do evil experiments on her. Total bs, but worked like a charm with her toddler mentality.

Realistic Tip 2: Allow yourself time to wander in circles from the reaction to the shock of the "event" that landed your patient in this predicament, along with the emotional upheavable that accompanies this type of major change in the family dynamics. Surprise recessive negative DNA will surface among family players that will blow your mind and perhaps create panic and rage. Breathe through it. For me, this all shook out in about a month after I mandated a "family meeting" and made assignments. Know who you can count on and put them to task. Whoever you CAN'T count on (such as an evil mother like mine), don't waste your time trying to align them, simply rule 'em out.

Realistic Tip 3: Don't lie, bait-n-switch, or bully your patient, the latter of which is SOOO hard to curtail at times. Think through what TO tell them, what NOT to tell them, and WHEN to tell them WHAT. Your little voice will dictate when to speak, what to say, and when zip yer lip~trust me.

Realistic Tip 4: Pose lots of questions to the "professionals" to get a clear picture to make an INFORMED decision! I discovered that I fall into the 1% of people who actually pose provocative questions to doctors, nurses, case workers, nursing home staff, etc. With docs, most folks only listen for or hear that magical phrase, "Oh you're doing great for your [condition] [age]!" Docs are quickly threatened by me (I do my best to subdue my delight) because I press answers out of them. I press them for details with a "why?" clarifier, sometimes composing my questions ahead of time on a piece of paper. Makes no sense with why their egos are damaged by this exchange...and that just may well be my next question posed to one of them.

Realistic Tip 5: Once you've acquired their confidence by accomplishing Tip #1, tackle the toddler mentality with tenacity! Implement the notion of rewards as well as consequences. Quietly acknowledge their fear of change and reluctance to facing their mortality. Do not argue for the sake of argument because you know what's best for them and remove the phrase, "yeah, but..." from your vocabulary. Apply a sense of empathy to everything you do and say to them~avoiding the "controlling" approach. Toddlers do well with a finite set of choices, so give your elderly patient alternatives to choose from. The goal is to transform it into their idea, their decision, and reinstates their sense of self-power.

Realistic Tip 6: Compromise will keep the momentum moving forward. I've made several "deals" with my Gram, albeit after exhaustive debate, and I've typed them out on a sheet that we both sign. If she promises to agree to [this] constraint, I promise to enforce [that] particular desire she refuses to part with.

Realsitic Tip 7: Apply tough love to the "pleeaassse!!! don't make me..." cry of desparation. Again, just as with a toddler, remain calm, wait out the meltdown, then continue the tough conversation. I also get creative with doing damage control later that day to smooth those ruffled feathers, just as you would broach a toddler to redirect their incessant pouting. Sometimes it's merely kind, loving, reassuring words, and other times I add a piece of banana cream pie (that she's not supposed to have), where the whole purpose is to re-establish trust on neutral ground.

Realistic Tip 8: Determine a Plan A and a Plan B, detailing the specific implementation of each, including dependencies, assumptions, and risks. For me, she will come live with me and my husband or stay in long term care after she recovers from the fracture. I have a whole list of conditions that must be met before I can determine which one is implemented.

Realistic Tip 9: If faced with housing your patient in long term care, (1) get a comprehensive list of all possible facilities (the social services dept of a hospital will have the most recent) in the county where your patient lives, then (2) show up at every one of them on a weekend day when staff is minimal and realistic conditions/dispositions are more readily present. I've found that querying the staff (not families) at a larger competitive facility will surface red flags about the other places, but you gotta be nonchalant about it. I've been extremely lucky that I've found two awesome LTC facilities (out of 12 in just the one area where my Gram lives~she's currently doing rehab in one of 'em). These two are less than a mile apart and actually operate in tandem to juggle each other's overflow to ensure that their resident's best interests are priority, and lastly (3) find out who your patient will be roommates with, see if you can meet them and their family first, then do a meet-n-greet between the roomies themselves BEFORE you follow through with any permanency. Any LTC facility that tells you,"well if they don't like their room, we can move them later," is one you should put on your "NO WAY" list.

Realistic Tip 10: For all the professional caretakers involved in your patient's transition from the home, hospital, one facility to another, clinics, transporation assistance, social workers, admit folks, and the like, (A) write down their names/take business cards and select a few to be your best friend(s), (B) make the time to send thank you notes to caretaker staff by group, signed by you, your alliances, and your patient, (3) for those rare glowing gems in the healthcare industry, I'd suggest writing a special note of gratitude to them accompanied by a box of artisinal chocolates.

Side note to the gluttonous: If you [or someone else involved] seeks to manage your patient's final phase with the intention of slanting the "family fortune" toward your favor, you'll also be sure to note how poetic justice prevails every time. Ahem!

My milestone date for deciding on her living arrangements is 9-24-2010, and is when I'll send another post with other lessons I've learned. Meanwhile, I wish you all perserverence, eh?!